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Decrease of Free Thyroxine Levels after Controlled Ovarian Hyperstimulation¹

Departments of Internal Medicine (A.F.M., A.B.), Obstetrics and Gynecology (A.V.), and Clinical Chemistry (M.J.M.), Zuiderziekenhuis Rotterdam, 3075 EA Rotterdam, The Netherlands; and Department of Internal Medicine III, University Hospital Dijkzigt (F.H.d.J.), 3015 GD Rotterdam, The Netherlands

Address correspondence and requests for reprints to: A. F. Muller, M.D., Department of Internal Medicine III, University Hospital Dijkzigt, Dr. Molewaterplein 40, Room D438, 3015 GD, Rotterdam, The Netherlands. E-mail: muller{at}inw3.azr.nl

Controlled ovarian hyperstimulation could lead to opposing effects on thyroid function. Therefore, in a prospective study of 65 women undergoing controlled ovarian hyperstimulation, thyroid hormones, T₄-binding globulin, TPO antibodies, gonadotropins, estradiol, and PRL were measured before and after controlled ovarian hyperstimulation.

After ovarian stimulation (mean ± SE of mean): free T₄ decreased, 14.4 ± 0.2 vs. 12.9 ± 0.2 pmol/L (P < 0.0001); thyroid-stimulating hormone increased, 2.3 ± 0.3 vs. 3.0 ± 0.4 mU/L (P < 0.0001); T₄-binding globulin increased, 25.2 ± 0.7 vs. 33.9 ± 0.9 mg/L (P < 0.0001); total T₄ increased, 98.1 ± 2.3 vs. 114.6 ± 2.5 nmol/L (P < 0.0001); total T₃ increased, 2.0 ± 0.04 vs. 2.3 ± 0.07 nmol/L (P < 0.0001); TPO antibodies decreased, 370 ± 233 U/mL vs. 355 ± 224 U/mL (P < 0.0001); LH decreased, 8.1 ± 1.1 vs. 0.4 ± 0.1 U/L (P < 0.0001); FSH did not change, 6.5 ± 0.6 vs. 7.9 ± 0.9 U/L (P = 0.08); human CG increased, <2 ± 0.0 vs. 195 ± 16 U/L (P < 0.0001); estradiol increased, 359.3 ± 25.9 pmol/L vs. 3491.8 ± 298.3 pmol/L (P < 0.0001); and PRL increased, 0.23 ± 0.02 vs. 0.95 ± 0.06 U/L (P < 0.0001).

Because low maternal free T₄ and elevated maternal thyroid-stimulating hormone levels during early gestation have been reported to be associated with impaired psychomotor development in the offspring, our findings indicate the need for additional studies in the children of women who where exposed to high levels of estrogens around the time of conception.

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